TCRN REVIEW - SPECIAL SITUATIONS (SHOCK,
PSYCHOSOCIAL ISSUES RELATED TO TRAUMA,
SIRS & MODS) (22 QUESTIONS ON EXAM)
Describe the process of
... [Show More] Obstructive Shock. - ANS Myocardium contracts against high afterload -
> Sympathetic over activity leads to vasoconstriction in order to maintain BP -> Despite normal
BP, organs are poorly perfused due to a reduction in blood flow -> Back pressure leads to
venous congestion
List the 4 Classifications of Shock - ANS Hypovolemic
Distributive
Cardiogenic
Obstructive
Describe hypovolemic shock - ANS Lack of Volume
Describe distributive shock - ANS Mal-distribution of blood (vasodilation)
Describe cardiogenic shock - ANS Inadequate cardiac output
Describe obstructive shock - ANS Inability of blood to enter or exit the heart adequately
What is another name for early hypovolemic shock? - ANS Compensatory Shock
The adrenergic system is active during the _____ phase of shock. - ANS Compensatory
The _____ system is active after the phase of shock has passed to bring the body back to a state
of homeostasis. - ANS Cholinergic
Another name for the sympathetic system is _____. - ANS Adrenergic system
Another name for the parasympathetic system is _____. - ANS Cholinergic system
What is the name of the process in which glycogen stores in the liver are broken down into
glucose? - ANS Glycogeonolysis
What is the process in which glucose in the serum is converted to glycogen for storage in the
liver? - ANS Glyconeogenesis
What is the term for the speed at which electricity moves through the heart? - ANS
Automaticity
What is the role of alpha receptors in the adrenergic (sympathetic) system? - ANS
Vasoconstriction, Glycogeonolysis, Diaphoresis
What is the role of the alpha receptors in the cholinergic (parasympathetic) system? - ANS
Vasodilation, Glyconeogenesis, Dry Skin
Sympathetic vs. Parasympathetic is also known as what? - ANS Fight or Flight; respectively
What is the role of Beta-One receptors in the adrenergic (sympathetic) system? - ANS
Increased: heart rate, contractility, automaticity
What is the role of Beta-One receptors in the cholinergic (parasympathetic) system? - ANS
Decreased: heart rate, contractility, automaticity
What is the role of Beta-Two receptors in the adrenergic (sympathetic) system? - ANS Increased
respiratory rate
Bronchodilation
What is the role of Beta-Two receptors in the cholinergic (parasympathetic) system? - ANS
Decreased respiratory rate
Bronchoconstriction
What is another term for late shock? - ANS Decompensated shock
What occurs during late or decompensated shock? - ANS Activation of the inflammatory system
During late or decompensated shock and the activation of the inflammatory system, what do
inflammatory mediators cause? (3 things) - ANS Vasodilation
Increased capillary permeability
Increased coagulation
What are the signs of early or compensated hypovolemic shock? (8 signs/symptoms) - ANS
Deceptively normal or slightly elevated blood pressure
Narrowing Pulse Pressure
Tachycardia (weak and thready)
Tachypnea (deep and rapid)
Normal serum lactate levels
Cool and clammy skin
CNS: anxious and restless
Decreased urinary output
What are the signs of late or decompensated hypovolemic shock? (7 signs/symptoms) - ANS
Decreased blood pressure
Tachycardia (may not be palpable peripherally)
Tachypnea (shallow and rapid)
Serum Lactate > 2-4 mmol/L
Cool, clammy and mottled skin
CNS: loss of consciousness
Anuria
What is the average blood volume of an adult? - ANS 4700-5500 ml
What is the average blood loss of a thoracic injury? - ANS 2000 ml
What is the average blood loss of an intra-abdominal injury? - ANS 2000 ml
What is the average blood loss of a tibial fracture? - ANS 650 ml
What is the average blood loss of a femur fracture? - ANS 1000 ml
What is the average blood loss of a pelvic fracture? - ANS 3000 ml
How many classes of hypovolemic shock are there? - ANS 4
Describe Class I hypovolemic shock: (8 answers) - ANS <750 ml of blood loss
<15% of blood loss
Pulse <100
Normal Blood Pressure
RR is 14-20
Urinary Output >30 ml/hr
CNS: slightly anxious
Fluid Replacement: Crystalloid
Describe Class II hypovolemic shock: (8 answers) - ANS 750-1500 ml of blood loss
15-30% of blood loss
Pulse 100-120
Normal Blood Pressure
RR is 20-30
Urinary Output 20-30 ml/hr
CNS: Mildly anxious
Fluid Replacement: Crystalloid
Describe Class III hypovolemic shock: (8 answers) - ANS 1500-2000 ml of blood loss
30-40% of blood loss
Pulse 120-140
Decreased Blood Pressure
RR is 30-40
Urinary output 5-20 ml/hr
CNS: Anxious and confused
Fluid Replacement: Crystalloid and Blood
Describe Class IV hypovolemic shock: (8 answers) - ANS >2000 ml of blood loss
>40% of blood loss
HR >140
Decreased Blood Pressure
RR >35
Urinary output: negligible
CNS: confused and lethargic
Fluid Replacement: Crystalloid and Blood
During which class of hypovolemic shock does blood pressure begin to decrease? - ANS Class III
Which class of hypovolemic shock should have consideration for blood replacement? - ANS
Class III
When evaluating the HR in hypovolemic shock, what should be considered? - ANS Patients
taking beta-blockers will not present with an increase in heart rate
Rather than Systolic or Diastolic BP, what are better indicators of shock? - ANS Pulse Pressure
(PP) or Mean Arterial Pressure (MAP)
How do you calculate the Mean Arterial Pressure (MAP)? - ANS Diastolic Pressure x2 PLUS
Systolic Pressure x1
Divide the total by 3
Ex: 120/70
70+70+120 = 260, then divide by 3 = 86.67
What is the treatment for hypovolemic shock? - ANS Aggressive airway management
Control Hemorrhage
IV/IO Access
Fluid Resuscitation
Prevent Hypothermia
Describe aggressive airway management in hypovolemic shock treatment: - ANS 100% oxygen
via non-rebreather with a goal of maintaining the SpO2 between 94% and 98%
Consider intubation and mechanical ventilation (avoid excessive pressure to protect the blood
pressure) [Show Less]